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Home , Clitoris, Sexual stimulation, Vagina

1355 ORIGINAL RESEARCH—/

G-Spot Anatomy: A New Discoveryjsm_2668 1355..1359

Adam Ostrzenski, MD, PhD, Dr Hab Institute of Gynecology, Inc., St. Petersburg, FL, USA

DOI: 10.1111/j.1743-6109.2012.02668.x

ABSTRACT

Introduction. The anatomic existence of the G-spot has not been documented yet. Aim. To identify the anatomic structure of the G-spot. Methods. A stratum-by-stratum vaginal wall dissection on a fresh cadaver. Main Outcome Measures. Primary outcome is the identification of the G-spot and the secondary outcome is its measurements and anatomic description of the G-spot. Results. The G-spot has a distinguishable anatomic structure that is located on the dorsal perineal membrane, 16.5 mm from the upper part of the urethral meatus, and creates a 35° angle with the lateral border of the . The lower pole (tail) and the upper pole (head) were located 3 and 15 mm next to the lateral border of the urethra, respectively. Grossly, the G-spot appeared as a well-delineated sac with walls that resembled fibroconnective tissues and resembled erectile tissues. The superior surface of the sac had bluish irregularities visible through the coat. Upon opening the sac’s upper coat, blue grape-like anatomic compositions of the G-spot emerged with dimensions of length (L) of 8.1 mm ¥ width (W) of 3.6–1.5 mm ¥ height (H) of 0.4 mm. The G-spot structure had three distinct areas: the proximal part (the head) L 3.4 mm ¥ W 3.6 mm, the middle part L 3.1 mm ¥ W 3.3 mm, and the distal part (tail) L 3.3 mm ¥ W 3.0 mm. From the distal tail, a rope-like structure emerged, which was seen for approxi- mately 1.6 mm and then disappeared into the surrounding tissue. Conclusion. The anatomic existence of the G-spot was documented with potential impact on the practice and clinical research in the field of female sexual function. Evidence-Based Medicine. Level II-3. Ostrzenski A. G-spot anatomy: A new discovery. J Med 2012;9: 1355–1359. Key Words. G-Spot; Cosmetic Gynecology; G-Spot Anatomy; Female ; Vaginal Anatomy; Female Sexual Function; Female Erectile Body; Gräfenberg’s Zone

Introduction where site-specific defects can be identified and reconstructed. This traditional gynecologic proce- very thoughtful scientific contribution to the dure has been executed for decades and, so far, no A challenging dilemma of the G-spot was the single scientific article reported any anatomic fact that the stimulation of the anterior vaginal wall structure corresponding to the G-spot being resulted in an approximately 50% swelling of the encountered during those many surgical interven- anterior distal vaginal wall and provided high levels tions. Therefore, the author concluded that the of with a powerful [1]. Also, it anterior vaginal wall, up to the pubocervical , has been presented that women had reported the most likely would not contain the anatomic G-spot location of the G-spot on the anterior vaginal wall and hypothesized that the G-spot maybe located approximately one-third to one-half up from the between the superior dorsal perineal membrane vaginal introitus [2]. A surgical dissection of the and the inferior pubocervical fascia. As it has been anterior vaginal wall is usually executed to the level documented that stimulation of the anterior of the pubocervical fascia (the endopelvic fascia) causes the vaginal wall to swell, a conclusion was

© 2012 International for J Sex Med 2012;9:1355–1359 1356 Ostrzenski

G-spot structure, which was located on the supe- rior surface of the dorsal perineal membrane, 16.5 mm from the upper part of the urethral meatus. The G-spot was identified as a sac with walls that grossly resembled the fibroconnective tissues, was easy to observe, and was a well- delineated structure. Also, the G-spot presented with limited mobility together with dorsal perineal membrane on which the G-spot was situated. The superior surface of the sac appeared as a mosaic of bluish irregularities visible through the coat. Upon opening the sac, the bluish grape-like anatomical composition of the G-spot was observed and dimensions established: length (L) of 8.1 mm, width (W) of 3.6–1.5 mm, and height (H) of Figure 1 The vestibular bulb was dissected and the prede- 0.4 mm. The G-spot structure had three distinct termined anterolateral vaginal stratum, aside from the parts: the proximal part (the head) with L lateral urethral border, was dissected for exploration. Under the vestibular bulb (above the scissors and between the 3.4 mm ¥ W 3.6 mm, the middle part with L scissor blades), the bluish structure, aside from the urethra 3.1 mm ¥ W 3.3 mm, and the distal part (tail ) with of G-spot, is depicted. L 3.3 mm ¥ W 3.0 mm. In the most distal tail, part was an indentation from which a rope-like (vessel) structure emerged. The vessel (rope-like) was drawn by the author that this structure must consist visible for approximately 1.6 mm and then disap- of erectile tissues that cause the anterior vaginal peared into the surrounding tissue. The G-spot wall to swell. Therefore, to test this hypothesis, the created a 35° angle with the anterolateral external objective was established to dissect the anterior border of the urethra at the level of 16.5 mm from vaginal wall layer by layer to potentially identify the the urethral meatus. The G-spot tail was located existence of the anatomy. The study’s results can 3 mm adjacent to the latero-external border of the have significant impact on the practice and clinical urethra and the head was located 15 mm research. (Figure 2). Upon removal of the entire structure with the adjacent margin tissues, the G-spot Material and Method stretched from 8.1 to 33 mm upon being freed up from the sac tissues (Figure 3). The study was conducted on a fresh cadaver at the A search for the existing literature was carried Department of Forensics Medicine, Warsaw out from 1900 to May 2010. Using Medical Medical University, Warsaw, Poland. The Subject Headings, which were selected and used in was 83-year-old multipara who expired from a search on the Information of Sciences Institute trauma to the head 24 hours before this study. The (ISI) Web of Science (including conference pro- stratum-by-stratum vaginal wall dissection was ceedings, 1950 PubMed, ACOGNET, ProQuest, executed from the vaginal , subepithe- OVID, Cochrone Collection, the Lancet on Line lium, smooth muscles (circular and longitudinal), Collection, MDConsultant, New England Journal and external fibrous layer connective (the endopel- of Medicine, American College of Physician on vic fascia) through the dorsal perineal membrane. Line Resources, Highwire Journal, and Citation The dissection stopped upon identifying the trans- Index Reference), and utilizing a manual search verse vaginal muscle and urethrovaginal sphincter failed to identify any anatomic documentation of muscle. The vestibular bulb (VB) was dissected the G-spot existence. Therefore, this presentation separately and documented (Figure 1). The ante- is the first description, in the scientific-clinical lit- rolateral areas located aside from the outer ure- erature, of the location, size, and gross presenta- thral border were explored (Figure 1). tion of the G-spot.

Results Discussion The vaginal wall dissection on the fresh cadaver In 1950, Ernest Gräfenberg from New York, USA established the presence of a separate anatomic presented his findings related to “the role of

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on the erotogenic aspect of the vagina, his name and the zone should not be used as a term for expression of the vaginal role in female sexuality. The G-spot has been functioning as a concept of a physiologic phenomenon that expresses woman’s personal sexual experiences. However, the anatomy of the G-spot has not been identified. The absence of the identification of the G-spot as an anatomic structure created considerable con- troversies and a biased interpretation of the scien- tific results worldwide, leading to a monolithic clitoral model of female sexual response. However, women have held the unwavering position that there are distinct areas in the anterior vagina which are responsible for a sensation of great Figure 2 The G-spot is depicted as bluish grape-like com- sexual pleasure. Therefore, it seems reasonable to positions that was located between the superior dorsal accept the notion that women are anatomically perineal membrane and the inferior pubocervical fascia and grossly resembles the cavernous tissue, which creates a equipped with a G-spot, which is sensitive to 35° angle with the lateral urethra. The rope-like structure tactile stimulation on the anterior vaginal wall. emerges from the tail that disappears into the adjacent Through the centuries, many attempts have tissue. The low pole is 3 mm and the upper pole is 15 mm been made to establish the anatomic existence, aside from the urethra. The G-spot’s housing was illustrated location, and size of the G-spot. It became one of that looked grossly a lot like the fibrotic-connective tissues. the most intellectual-provoking topics on the female sexual expression field. The results of the recent attempt were presented in 2009 [5]. The urethra in female orgasm” [3]. Although his anatomic documentations of the G-spot provided research did not focus on the role of the vagina in in this clinical intra-operative study clearly indi- the female orgasm, in 1981, Addiego et al. named cated the presence of the Skene’s peri-urethral the vaginal erotogenic zone the Gräfenberg zone glands and the Skene’s para-urethral ducts, which and later on the international media established are located between the inferior urethra and the the term of G-spot [4]. The G-spot has been superior vagina and they have been labeled as a adapted by the medical field and the public at large G-spot [5]. In addition, the superficial location of around the globe. Since Gräfenberg did not work the G-spot anatomy did not correspond to the author’s findings presented here. Also, histologic documentations offered in the study from 2009 are typical for the Skene’s glands and ducts [5,6]. The current study documented that the G-spot did not run alongside of the urethra, as it was claimed in the article quoted above [5], but the G-spot creates a 35° angle between the urethra with the lower pole being positioned 3 mm from the urethra and the upper pole being situated 15 mm from the urethra. The current study established that the G-spot location was located much more deeply than it was previously observed during the anterior vaginal repair performed in 2009 [5]. The current study documented that the superior dorsal perineal membrane is the structure on which the G-spot is situated. The G-spot is not “. . . small flaccid balloon-like masses on either side of the Figure 3 The G-spot was excised with the margin of the urethra” as previously stated [5]. It is a well- adjacent tissue. The structure looked like the cavernous tissues. Upon opening the upper sack’s wall, the G-spot defined and uniform structure within a sack and stretched from 8.1 mm being compacted in the sack to the G-spot appeared to be without 33 mm being freed up from the sack tissues. any palpable gland within the tissues. Therefore,

J Sex Med 2012;9:1355–1359 1358 Ostrzenski neither anatomic nor histologic data presented in urethrovaginal sphincter muscle. The vaginal- the 2009 intra-operative study corresponded to urethral reach from the lateral part of the the anatomic G-spot existence [5]. anterior vaginal wall to the sides of the urethra and There are scientific data that strongly support then run subcutaneously to the , where they the physical presence of the G-spot. The G-spot unite around the base [10,11]. gene has been identified and has been already Additionally, O’Connell et al. brought to our incorporated into the Affymetrix GeneChip attention that classic textbooks that provide microarrays of probes to match specified genes [6]. descriptions of the female anatomy should be The vaginal electric activities (the electrovagino- revised, as there are significant differences gram) documented that a pacemaker was posi- between modern anatomy, supported by the Mag- tioned to exist at the upper vagina evoking electric netic Resonance Imaging (MRI) results, and tradi- waves that could be recorded. Shafic et al. con- tional presentations. Also, O’Connell’s group cluded that the vaginal pacemaker seemed to rep- suggested new anatomic terminologies and the resent the G-spot, which women reported as a author supports this notion [12,13]. The results of small area of erotic sensitivity in the vagina [7]. our study presented in this article confirmed the The ultrasonographic study postulated that clito- need for revision of traditional approaches in text- ral bodies have a descending movement and come books related to the female anatomy and close to the distal anterior vaginal wall during a new terminologies should be considered. voluntary contraction and relaxation of the pelvic The anatomic discovery of the G-spot existence floor muscles. Investigators suggested that this fact may inspire a new study for establishing the ana- can explain the particular sensitivity of the G-spot tomic presence of “a female prostate.” Recently, and its role in the female orgasm [8]. the immunohistochemical study suggested that In this study, significant attention was given to female prostate characteristic components can be compare the VB gross anatomy and the G-spot gross identified in some women [14]. Other study sub- anatomy. Grossly, the differences between VB and stantiated the notion of “a female prostate” exist- G-spot are striking including the location and the ence and the results of the study documented that angulation of the G-spot, which creates a 35° angle the real female consists of two fractions with the lateral urethra. The VB has a much longer with distinct components: diluted and structure than the G-spot (Figures 1 and 2). The second fraction presents with very scanty, thick, distal part of VB is much thicker than the proximal and whitish fluid resembling prostatic secretions part; it is very opposite in the case of the G-spot [15]. The anatomy of “a female prostate” structure where the distal part is thinner than the proximal still is waiting for its discovery. part. In the middle of the distal part of the G-spot, the rope-like structure is present and VB configura- Conclusion tion does not have such a structure. The similarity on the gross examination between VB and G-spot was The anatomic existence of the G-spot was docu- present in bluish grape-like compositions and both mented in this study with potential impact on the grossly resemble the cavernous tissue. practice and clinical research in the field of female It is worthwhile to mention the modern, well- sexual function. designed, well-executed, and well-presented female genital anatomy study, which was conducted Acknowledgments by O’Connell et al. [9]. Although the authors’ The author wishes to thank Prof. Pawel Krajewski, MD, research had not integrated the G-spot anatomy, it PhD, Dr Hab, Chairman of the Department of Forensic is worthwhile to elaborate on the new concept of Medicine, Warsaw Medical University, Poland, for pro- the clitoral complex, which may be integrated with viding access and materials for the study; Andrzej J. the G-spot in the future. The clitoral complex that Barwijuk, MD, PhD, Director of Medifem, Warsaw, was introduced by O’Connell’s group incorporates Poland, for getting permission to perform the study at the clitoris, distal vagina, and the urethra [9]. This the Department of Forensic Medicine; Mark N. Shein- berg, MD, Director of the Center for Cosmetic and discovery brings to light a better understanding of Reconstructive Gynecology, Deerfield Beach, FL, USA, the anterior distal vaginal wall and the urethra’s for photodocumentation; Michal Barwijuk, MD, the role in the of active forces generated staff member of Medifem, Warsaw, Poland, for assisting during to the clitoris. From the during dissection; and Troy R. Hailparn, MD, from San anatomic point of view, it does make a lot of sense as Antonio, TX, USA, for assisting in preparation of this the vaginal introitus is intimately fused with the manuscript.

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Corresponding Author: Adam Ostrzenski, MD, PhD, 3 Gräfenberg E. The role of urethra in female orgasm. Int J Dr Hab, Institute of Gynecology, Inc., 7001 Central Sexol 1950;3:145–8. Ave., St. Petersburg, FL 33710, USA. Tel: (727) 458- 4 Addiego F, Belzer EG, Comolli J, Moger W, Perry JD, Whipple B. : A case study. J Sex Res 6060; Fax: (727) 341-0121; E-mail: [email protected] 1981;17:1–13. Conflict of Interest: None. 5 Thabet SAM. Reality of the G-spot and its relation to female and vaginal surgery. J Obstet Gynaecol Res 2009;35:967–73. Statement of Authorship 6 Upton GJ, Langdon WB, Harrison AP. G-spots causes incor- rect expression measurement in Affymetrix microarrays. BMC Category 1 Genomics 2008;9:613. (doi:10.1186/1471-2164-9-613). (a) Conception and Design 7 Shafic A, Sibai EIO, Shafik AA, Ahmed I, Mostafa RM. The Adam Ostrzenski electrovaginogram: Study of the vaginal electric activity and its role in the sexual act and disorders. Arch Gynecol Obstet (b) Acquisition of Data 2004;269:282–6. Adam Ostrzenski 8 Foldes P, Buisson O. Clitoris and G-spot: An intimate affair. (c) Analysis and Interpretation of Data Gynecol Obstet Fertil 2007;35:3–5. Adam Ostrzenski 9 O’Connell HE, Med M, Eizenberg N, Rahuman M, Cleeve J. The anatomy of distal vagina: Towards unity. J Sex Med Category 2 2008;5:1883–91. 10 Ingelman-Sundberg A. The anterior vaginal wall as an organ (a) Drafting the Article for the transmission of active forces to the urethra and the Adam Ostrzenski clitoris. Int Urogynecol J Dysfunct 1997;8: (b) Revising It for Intellectual Content 50–1. Adam Ostrzenski 11 Ostrzenski A. The first clinical classification of vaginal introital defects. Eur J Obstet Gynecol Reprod Biol 2011;159:449–52. Category 3 [Epub ahead of print]. 12 O’Connell H, Sanjeevan KV, Hutson JM. Anatomy of the (a) Final Approval of the Completed Article clitoris. J Urol 2005;174:1189–95. Adam Ostrzenski 13 O’Connell HE, Hutson JM, Anderson CR, Plenter RJ. Ana- tomical relationship between urethra and clitoris. J Urol References 1998;159:1892–7. 14 Dietrich W, Susani M, Stifter L, Haitel A. The human female 1 Ladas AK, Whipple B, Perry JD. The G-spot and other dis- prostate-immunohistological study with prostate-specific coveries about . New York, NY: Hot, Rine- antigen, prostate-specific alkaline phosphatase, and hart, and Winston; 1982. receptor and 3-dremodeling. J Sex Med 2011;8:2816–21. 2 Crooks R, et al. Our sexuality. 7th edition. Brooks/Cole, CA: 15 Rubio-Casillas A, Jannini EA. New insights from one case of Pacific Grove; 1999. female . J Sex Med 2011;8:3500–4.

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